PDF(Pubmed)
Abstract：
Despite prior publications of clinical practice guidelines related to ventilator liberation, some questions remain unanswered. Many of these questions relate to the details of bedside implementation. We, therefore, formed a guidelines committee of individuals with experience and knowledge of ventilator liberation as well as a medical librarian. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we make the following recommendations: (1) We suggest that calculation of a rapid shallow breathing index is not needed to determine readiness for a spontaneous breathing trial (SBT) (conditional recommendation; moderate certainty); (2) We suggest that SBTs can be conducted with or without pressure support ventilation (conditional recommendation, moderate certainty); (3) We suggest a standardized approach to assessment and, if appropriate, completion of an SBT before noon each day (conditional recommendation, very low certainty); and (4) We suggest that FIO2 should not be increased during an SBT (conditional recommendation, very low certainty). These recommendations are intended to assist bedside clinicians to liberate adult critically ill patients more rapidly from mechanical ventilation.
摘要：
尽管以前发表了与呼吸机释放有关的临床实践指南，一些问题仍然没有答案。这些问题中的许多与床边实施的细节有关。我们,因此,成立了一个由具有呼吸机解放经验和知识的个人以及医学图书馆员组成的指导委员会。使用建议评估的分级，发展,和评估(等级)方法，我们提出以下建议：（1）我们建议不需要计算快速浅呼吸指数来确定自主呼吸试验（SBT）的准备情况（有条件的；中等确定性）；（2）我们建议可以在有或没有压力支持通气的情况下进行SBT（有条件的建议，适度的确定性)；(3)我们建议一种标准化的评估方法，如果合适,每天中午前完成SBT(有条件推荐，非常低的确定性)；(4)我们建议在SBT期间不应增加FIO2(有条件建议，非常低的确定性)。这些建议旨在帮助床边临床医生更快地将成年危重患者从机械通气中解放出来。
